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Is shorter antibiotic treatment duration increasing the risk of relapse in paediatric acute focal bacterial nephritis?
  1. Nina Vaezipour1,2,
  2. Katrina Evers3,
  3. Hanna Schmid4,
  4. Nicole Ritz2,5,6,
  5. Alexandra Goischke3
  1. 1Department of Paediatric Infectious Diseases and Vaccinology, University Childrens Hospital Basel, Basel, Switzerland
  2. 2Mycobacterial and Migrant Health Research Group, University of Basel and Department of Clinical Research, Basel, Switzerland
  3. 3Department of Paediatric Nephrology, University Childrens Hospital Basel, Basel, Switzerland
  4. 4Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, UK
  5. 5Department of Paediatrics and Paediatric Infectious Diseases, Childrens Hospital Lucerne and Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
  6. 6Department of Paediatrics, The Royal Childrens Hospital Melbourne, University of Melbourne, Parkville, Victoria, Australia
  1. Correspondence to Dr Nina Vaezipour, Department of Paediatric Inectious Diseases and Vaccinology, University Childrens Hospital Basel, 4056 Basel, Switzerland; nina.vaezipour{at}ukbb.ch

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Scenario

A 12-year-old girl presented with another episode of pyelonephritis. Her history was remarkable for multiple prior episodes of pyelonephritis over several months. Each episode was accompanied by flank pain and fever. Urine culture showed Escherichia coli on all occasions. Treatment for the first episodes was with oral cephalosporins for 10 days. Renal ultrasound did not show any abnormality of the urinary tract and the performed uroflow was normal. Underlying risk factors for recurrence of pyelonephritis such as bowel–bladder dysfunction and constipation were ruled out. A sufficient oral fluid intake as well as complete bladder voiding were discussed with the patient and her parents and were reported to be adequate.

During the current episode, an MRI was performed, suggesting a diagnosis of an acute focal bacterial nephritis (AFBN). A 2-week course of intravenous ceftriaxone was given followed by oral prophylactic treatment. Nonetheless, clinical relapse and new renal lesions on the follow-up MRI 6 weeks later were seen and prompted the team to treat her condition with a prolonged course of intravenous ceftriaxone over 4 weeks.

You wonder if an earlier prolonged antibiotic therapy for AFBN could have reduced the risk of recurrences.

Structured clinical question

In children with evidence of AFBN (population), is short duration of initial antimicrobial therapy (intervention) associated with the risk of recurrence (outcome)?

Search

Primary search was conducted in EMBASE and MEDLINE via Ovid, PubMed and Google Scholar without time and language restriction (table 1). Search terms included acute focal bacterial nephritis, acute lobar nephronia, children, pediatric, relapse, recurrence. One hundred fifty-five unique potential articles were screened, with three …

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Footnotes

  • NR and AG contributed equally.

  • Contributors NV formed the clinical question and reviewed the literature. NV wrote the manuscript. AG and NR critically reviewed the study proposal and contributed to the manuscript. HS, KE, NR and AG proofread the drafts and added further input. All authors (NV, HS, KE, NR and AG) proofread and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.